Healthcare Provider Details

I. General information

NPI: 1972922821
Provider Name (Legal Business Name): PREMAPLAY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2014
Last Update Date: 11/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WESTWOOD SQ. SUITE D W. HWY 426
OVIEDO FL
32765
US

IV. Provider business mailing address

465 S. ORLANDO AVE #320
MAITLAND FL
32751
US

V. Phone/Fax

Practice location:
  • Phone: 407-790-5601
  • Fax: 407-602-7858
Mailing address:
  • Phone: 407-790-5601
  • Fax: 407-602-7858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT15041
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT15041
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberOT15041
License Number StateFL

VIII. Authorized Official

Name: MS. REBECCA DRAY
Title or Position: OWNER
Credential:
Phone: 407-790-5601